Provider Demographics
NPI:1750671293
Name:NEWTON, BREANNA BROOKE (PHARM D)
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:BROOKE
Last Name:NEWTON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 HIDDEN OAK LN
Mailing Address - Street 2:HOME ADDRESS
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-7123
Mailing Address - Country:US
Mailing Address - Phone:337-656-2578
Mailing Address - Fax:
Practice Address - Street 1:115 W MCNEESE ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5635
Practice Address - Country:US
Practice Address - Phone:337-474-4131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.018488183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist